Do you have a sex problem which you would like us to help sort out? Then email us at www. thehotbedcollective.com This is the second in our series. Dr Karen Gurney, @thesexdoctor on Instagram, and director of the Havelock Clinic, answers one reader question...
Hello, I am almost 47 & going through menopause (for last 2 yrs) although not been confirmed by GP. I also suffer from anxiety & depression. Not on medication atm. I hate going to doctor basically. I have very little sex drive & this has been the case for some months. I force myself to have sex occasionally and whilst my partner is very understanding, its putting a strain on our relationship. I know I need to go to doctor re anxiety etc but what about the sex drive??
Dr Karen Gurney says:
Thanks for your question. I’m really glad you wrote in as there’s lots that can help here.
The menopause is a big physical and psychological transition for women and is triggered by a steep reduction in oestrogen and testosterone circulating in the body. Oestrogen and androgens such as testosterone are the key physical drivers for desire (there are lots of other physical and psychological drivers- it’s a complex picture), and so a reduction in these hormones as we see just before, during and after the menopause has been shown to be very strongly associated with a drop in sex drive for a large proportion of women.
It’s also worth noting that the menopause is also responsible for other structural changes to our body and genitals (such as thinning of the genital skin, vaginal pain and dryness, and changes to mood.) These combined with the psychological aspects of how we feel about changes to our body, fertility, etc can also be responsible for sex feeling less appealing, being less comfortable, having difficulties getting turned on or reaching orgasm or experiencing painful sex.
It’s also good for us to have a think about the effects of anxiety and depression on libido (both of them can reduce sex drive and sexual confidence). You didn’t mention whether you had struggled with anxiety and depression before all this? I wonder whether they are a separate issue or connected to (or worsened by) your change in hormone levels. For example, the mood changes could be a consequence of your loss of desire and the strain in your relationship, or the change in your hormone levels could be the cause of your low mood. If you were coming to see me in clinic I’d be wanting to find out a bit about the history of this, where it fitted in to the difficulties with sex and whether you need support with your mood more generally (visit the NHS Increasing Access to Psychological Therapies website http://www.nhs.uk/Service-Search/Psychological%20therapies%20%28IAPT%29/LocationSearch/10008 to find details of your local service, of which you can often self-refer). It saddens me that many people reporting mood disorders to their GP are prescribed anti-depressants rather than talking therapies when this is not the guidance recommended to the NHS by NICE (National Institute of Clinical Excellence). Anti-depressants have their place but can also contribute to sexual dysfunction. If your GP suggests them please ask about talking therapies too and make a decision about which, if any, is best for you right now.
It’s important to note that even though the menopause is closely associated with sexual problems for women there are many things that will help. For example, Hormone Replacement Therapy (HRT) will resolve the low oestrogen and testosterone and also prevent further hormone related physiological changes. HRT will also contribute to an improvement of mood if the anxiety and depression is linked with the drop in oestrogen, which it can be in many cases. Oestrogen cream that you apply yourself can make a difference to the genital changes and make sex more pleasurable and comfortable again. Lube is a godsend for everybody and if it were up to me I’d honestly make it compulsory for everyone to use it all of the time! The older we get the harder it is for us to get wet generally and especially around and after the menopause using plenty of lube will make a big difference to your comfort and enjoyment when sex does happen. All of these things should make a big difference to how things have been if the menopause is the underlying cause.
I’m pleased that your partner is understanding. Often partners can perceive a change in sex drive to be about them which is part of the reason it can become a problem for both people. It can be interpreted as a devastating change in attraction or commitment which may often be incorrect. You don’t mention how long you’ve been together and how sex was before, but its worth knowing that research tells us that the quality of the pre- menopause sex life you had together will affect how you both feel about it afterwards. Concern about how much sex couples are having is often something that couples worry about a lot. One thing we often spend some time on in our therapy sessions or online workshops is why this matters and how we can work around it. If you are already good at talking about sex together, great- keep doing this as much as you can. Reassure each other and let each other know how you are feeling and what you think might help. If you don’t feel talking about sex is that easy (many people don’t!), you might find some sessions of sex therapy useful if things continue. Make sure you see someone who has special training in working with sexual problems though, this is really important (I’ve written a blog on this which you can read here http://thehavelockclinic.com/2016/12/28/finding-a-suitable-sex-therapist/ .
Forcing yourself to have sex can be good and bad in equal measure! For example, if forcing yourself means you don’t feel like it, don’t get aroused, don’t have pleasure and feel discomfort my advice would be to stop having sex for now. Negative experiences of sex are not good for our long term sexual desire. But, women’s desire is fairly good at being kickstarted so if it’s the case for you that once you’ve started you are able to get into it and experience enjoyment then keep doing it. Just keep that lube nearby please!
I’m pleased that you are thinking about going to the doctor and I would say that this is essential. Although you have a good idea this is the start of the menopause, it would be useful to have them check this out and confirm it to you. You should definitely mention your concerns about your sex drive to your GP, it’s likely to be part of a bigger picture related to what’s currently happening with your health and will help them decide what might be useful for you moving forward. Remember that this is so common, that your GP will have heard it many times before and not be phased by you raising it.
Lastly, the good news is that many women report a reduction in desire after the menopause which they are totally happy with, and sometimes the issue is about readjusting as a couple to what your future sex life will be like in a way that suits you both. For example, I worked with a couple in their 50’s recently that used this opportunity to totally redefine how they had physical intimacy, so that it revolved much less around traditional ideas about sex and much more around erotic touch and closeness. For them it totally paid off, as they now feel they are in a new and exciting phase that’s redefined how sex will be for them moving forward.
Dr Karen Gurney
Clinical Psychologist and Psychosexologist
Director- The Havelock Clinic